We report a case of a bihemispheric paradoxical cerebral embolism in a patient with pulmonary thromboembolism and presumptive pulmonary arteriovenous fistula. The echocardiogram showed no intracardiac shunt, and the transcranial Doppler (TCD) revealed spontaneous microembolic signals in the middle cerebral arteries (MCAs), and late passage of a higher number of microembolic signals in the MCAs, compatible with right-to-left shunt (RLS). The TCD and the echocardiogram were useful for identifying the RLS when rapid neurological deterioration occurred.
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- Paradoxical embolism: clinical presentation, diagnostic strategies, and therapeutic options.Am Heart J. 1986; 112: 141-145
- Paradoxical cerebral embolism secondary to pulmonary arteriovenous fistula (letter).Stroke. 1990; 21: 504-505
- Transcranial Doppler of a paradoxical brain embolism associated with a pulmonary arteriovenous fistula.AJNR Am J Neuroradiol. 1999; 20: 1881-1884
- Management of right-to-left shunt in cryptogenic cerebrovascular disease: results from the observational Austrian paradoxical cerebral embolism trial (TACET) registry.J Neurol. 2013; 260: 260-267
- Paradoxical brain embolism in a young man: is it only patent foramen ovale?.Neurol Neurochir Pol. 2015; 49: 61-64
- Mechanisms of bihemispheric brain infarctions in the anterior circulation on diffusion-weighted images.AJNR Am J Neuroradiol. 2005; 26: 809-814
- Pulmonary arteriovenous fistula and hereditary telangiectasia.Dis Chest. 1963; 43: 449-455
- Pulmonary arteriovenous malformation (PAVM): rare cause of hemoptysis.J Ayub Med Coll Abbottabad. 2013; 25: 100-102
- Pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: a series of 126 patients.Medicine (Baltimore). 2007; 86: 1-17
- Pulmonary arteriovenous malformations: cerebral ischemia and neurologic manifestations.Neurology. 2000; 55: 959-964
Published online: April 19, 2016
Accepted: March 19, 2016
Received in revised form: March 14, 2016
Received: February 3, 2016
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.